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Public Health Extension of the Primary Care EHR
Session #47, February 12, 2019
Fred Rachman, MD, Chief Executive Officer, AllianceChicago
Nivedita Mohanty, MD, Chief Research Officer, AllianceChicago
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Fred Rachman, MD
Nivedita Mohanty, MD
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• The Intersection of the Public Health System and Health Care
Delivery System
• Community Based Public Health Surveillance Projects
• Behavioral Risk Factor Surveillance System (BRFSS)
• Predictive Analytics for Lead Hazard Prevention
• Sexually Transmitted Infection electronic case reporting
• Future Directions
Agenda
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• Recognize how disparate information systems from the public and
healthcare sectors can improve information sharing of disease prevalence
and can surface the needs of populations who are at highest risk due to
social determinants
• Describe how predictive analytics applied to public health can improve
clinical practice
• Discuss the value of leveraging data and partnerships to change the
current model of clinical care from being reactive to proactive in various
public health domains
• Identify public health functions and use cases that can integrate with
primary care workflows leveraging interoperable technology
• Evaluate opportunities within current practice to apply approaches
discussed in either primary care or public health settings
Learning Objectives
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Our Mission: To improve personal, community and
public health through innovative collaboration.
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Public Health
System
Health Care
Delivery System
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Public Health Functions
• Environmental factor identification and intervention
• Surveillance
• Disease Control
• Disease Outbreak and Emergency Management
• Risk identification and management
• Public Health Awareness
• Education
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Community Based Public
Health Surveillance Projects
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Infectious Disease Surveillance
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Public Health Alerting schema
Demographic
s on patients
with relevant
symptoms
Primary
Care
EMR
Alert
generated if
patient
demographic
s match an
active
outbreak
report
CDC
Public
Health
Database
Patient
specific alert
to provider at
proper time
in the
workflow
Primary
care
EMR
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Factors Influencing Health
0% 20% 40% 60% 80% 100%
Healthcare
Genetics
Social, Environmental Behvioral
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Patients with SDH
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Health eRx
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The Behavioral Risk Factor
Surveillance Survey (BRFSS)
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History and background of the
BRFSS
• In 1984, the Centers for Disease Control and Prevention (CDC)
established the Behavioral Risk Factor Surveillance System
(BRFSS).
• BRFSS is the nation’s premier system of health surveys that
collect state data about U.S. residents regarding their health-
related risk behaviors and events, chronic health conditions, and
use of preventive services.
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Individual BRFSS
Public
Health
System
?
Primary Care
Practice
Individual
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DATA
LIQUIDITY
HEALTH SYSTEM REALM
PUBLIC HEALTH REALM
CONSUMER REALM
HEALTH CARE PROVIDER
REALM
BRFSS
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DATA
LIQUIDITY
HEALTH SYSTEM REALM
PUBLIC HEALTH REALM
CONSUMER REALM
HEALTH CARE PROVIDER
REALM
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Data Across Sectors for Health:
Lead Prevention Project
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Background: Lead Poisoning
• Imposes devastating health, social, and economic costs
annually
• Disproportionately impacts vulnerable populations including
those served by community health centers (CHCs)
• In Chicago, over 80% of housing was built before the 1978 lead
paint bans
• Nearly 2,000 children test positive for lead poisoning every year
• Silos of data on the prevalence of lead can impede efforts to
address social determinants of health
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CHILD POISONEDCHILD POISONED LEAD IDENTIFIEDLEAD IDENTIFIED
REMEDIATION
MITIGATION
ABATEMENT
REMEDIATION
MITIGATION
ABATEMENT
REACTIVE
PROACTIVE
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Lead Paint Hazards Persist
Children living in neighborhoods
with a low opportunity index are
5x more likely to have an
elevated blood lead level than
those in high opportunity
neighborhoods
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Innovative Collaborations:
Electronic Sexually Transmit
Case Reporting (eCR)
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Background: Burden of STIs in Illinois
Case Counts of Gonorrhea:
• 13,608 (Cook County, 2015)
• 17,130 (Illinois, 2015)
Case Counts of Chlamydia:
• 41,056 (Cook County, 2015)
• 69,610 (Illinois, 2015)
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Problem Statement:
Case Reporting is Manual and Time Consuming leading to
Inaccurate Disease Surveillance
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Scope of Pilot Implementation
EHR applies case
detection logic to
patient encounter
data in EHR
EHR applies case
detection logic to
patient encounter
data in EHR
Patient’s data
meet reporting
criteria
Patient’s data
meet reporting
criteria
EHR*
builds case
report
EHR*
builds case
report
EHR*
sends
case report
EHR*
sends
case report
*may involve middleware
(e.g., 3rd party interface
engine)
AllianceChicago (GE Centricity) AllianceChicago (GE Centricity)
Match
to
trigger
codes
Pull
case
report
element
s
Patient’s
encounte
r data
entered
into EHR
Patient’s
encounte
r data
entered
into EHR
Receive
case
report
Receive
case
report
De-
duplicate
from ELR
De-
duplicate
from ELR
Categorize
for case
classificatio
n
Categorize
for case
classificatio
n
Add case
to
surveillanc
e system
Add case
to
surveillanc
e system
Conduct
case
investigatio
n
Conduct
case
investigatio
n
Case
notification
to CDC
Case
notification
to CDC
Illinois Department of Public HealthIllinois Department of Public Health
......
We
are
her
e
We
are
her
e
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PHII/DSTDP Case Detection Logic
Patient
Encounter
Scenario
Diagnosis
Lab Test
Performed
Positive Lab
Result (Named
Organism)
Positive Lab Result
(Presence vs.
Absence)
Treatment
Prescribe
d
Send
eCR
?
1      YES
2      YES
3      YES
4      NO
5      NO
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Next Steps/Recommendations
• Collaborate with IDPH/CDPH to receive eCRs
and onboard into their surveillance system
• Revise data to capture in the eCR
-Medications administered at the follow-up
treatment visit
-Medications prescribed at the follow-up
treatment visit
-Other follow up (e.g., partner screening referral)
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Future Directions:
Integrating Primary Care
and Public Health
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Interoperable Clinical Decision Support
https://cds.ahrq.gov/cdsconnect
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Public Health
System
Health Care
Delivery System
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Public Health System
Health Care
Delivery
System
